DMMA-Mail Survey New (ed) 7-24-08

OMB No.: XXXX-XXXX

Expiration Date: XX/XX/20XX

Evaluation of Care and Disease Management under Medicare Advantage

Mail Survey

June 4, 2008

Draft

MPR ID Number: | | | | | | | | |

Medicare Advantage Contract Number: | | | | | |

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is XXXX-XXXX. The time required to complete this information collection is estimated to average 45 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, N2-14-26, Baltimore, MD  21244-1850.

OVERVIEW AND important INSTRUCTIONS: Please read

This survey has been designed to collect information on care and disease management programs provided by Medicare Advantage contractors. The survey is being conducted for the Centers for Medicare & Medicaid Services (CMS) by Mathematica Policy Research, Inc. (MPR).

Individual responses to this survey will be kept private to the fullest extent permitted by law. Answers from all responding contract holders will be tabulated and provided to CMS in aggregate form only. Responses will not be linked to individual contracts, plans, or respondents.

OVERVIEW OF THE SURVEY

The first section (A) of this survey asks about the contract holder’s maintenance of member-level electronic data.

Sections B and C ask about care and disease management interventions with members, respectively. For the purposes of this survey we draw the following distinction between care management and disease management:

First, care management, sometimes referred to as care coordination, case management, or complex case management. For the purposes of our survey, by care management we mean:

A group of services for members who have multiple medical or behavioral health conditions or who are medically complex. It often involves assigning a member to a single staff person or team to monitor the member’s clinical care and services, to assist with transitions between care settings, and to help the member access needed health and support services.

By contrast, by disease management we mean:

Services that: teach members how to adhere to their physicians’ treatment plans; monitor member clinical status and adherence to treatment recommendations; and monitor provider adherence to evidence-based practice guidelines. Disease management is typically targeted to members with specific chronic diseases, such as heart failure or diabetes. Such diseases often have complex treatment regimens, and maintaining adherence requires the sustained efforts of patients and physicians.

Section D asks about care and disease management interventions with physicians.

Section E asks contractors operating Special Needs Plans (SNPs) to compare care and disease management programs under the SNP with programs offered under regular Medicare Advantage plans.

Section F asks how your organization assesses the effectiveness of its care and disease management programs.

INSTRUCTIONS

1. Please answer only about the care or disease management programs provided under the contract with Medicare specified on the cover to this document.

2. If your organization contracts out some or all of its care or disease management services (for example, to a disease management vendor), please answer questions both in terms of your organization AND others with whom you contract.

3. We recognize that some contract holders may view their care and disease management services as a single program. If this is the case for your organization, we nevertheless request that you make the operational distinction inherent in the working definitions provided above, and answer both survey sections B and C.

4. All questions in this document refer to the current status of your Medicare Advantage contract, unless otherwise noted.

5. When questions refer to interactions with “members” please also include members’ health care decision makers, as appropriate.

6. When filling out this questionnaire, always proceed to the next question unless special instructions tell you to go elsewhere.

7. Most questions can be answered by simply placing a check mark in the appropriate box. For a few questions you will be asked to write in a response. Feel free to elaborate on any responses in the questionnaire margins or to provide additional thoughts or documentation about your program at the end of the questionnaire.

8. Please return the completed questionnaire within the next two weeks in the enclosed return mail envelope to Mathematica Policy Research, Inc., P.O. Box 2393, Princeton, New Jersey 08543-2393, ATTN: Emily Dwoyer, or fax it to (609) 799‑0005. If you have any questions, please call Emily Dwoyer at (609) 275‑2231.

PLEASE FILL IN:

TODAY’S DATE: | | | / | | | / | | | | |

MONTH DAY YEAR

YOUR NAME AND TITLE:

WORK TELEPHONE NUMBER/EXT.:(| | | |)-| | | |-| | | | |-| | | | |

YOUR E-MAIL ADDRESS: @

Section A: Electronic Data Systems

A1. Which of the following types of member-level electronic data are directly maintained by your organization?

mark yes or no for each	Yes	No
a. Enrollment or disenrollment dates	1 	0 
b. Service use or charges	1 	0 
c. Prescription drug use or charges	1 	0 
d. Procedure codes, such as CPTs	1 	0 
e. Clinical indicators, such as lab test results	1 	0 
f. Quality-related process of care information, such as receipt of prevention screening or immunizations	1 	0 
g. Assessments or care plans	1 	0 
h. Please list other types of member-level electronic data your plan maintains	1 	0 

For the purposes of this survey we draw the following distinction between care management and disease management:

By care management (sometimes referred to as care coordination, case management, or complex case management) we mean:

A group of services for members who have multiple medical or behavioral health conditions or who are medically complex. It often involves assigning a member to a single staff person or team to monitor the member’s clinical care and services, to assist with transitions between care settings, and to help the member access needed health and support services.

By disease management we mean:

Services that: teach members how to adhere to their physicians’ treatment plans; monitor member clinical status and adherence to treatment recommendations; and monitor provider adherence to evidence-based practice guidelines. Disease management is typically targeted to members with specific chronic diseases, such as heart failure or diabetes. Such diseases often have complex treatment regimens, and maintaining adherence requires the sustained efforts of patients and physicians.

Section B asks about care management and Section C asks about disease management. If plans under your contract provide both care and disease management, please answer the questions in both Sections B and C.

Section B: Characteristics of Care Management Programs

B1. Is care management available to members served under this contract? Please do not include as care management short-term or single-event services available to all members, such as pre-admission screening or the services of a health advocate.

1  Yes — Go to B2

0  No — Go to Section C

B2. Is care management provided by staff employed by the contract holder, a vendor, network providers (such as primary care physicians), or others not directly employed by the contract holder?

mark all that apply

1  Contract holder staff

2  Vendor

3  Plan network provider

4  Provided by other non-contract holder staff (Please specify)

Remember, if your organization contracts out some or all of its care management services, please answer the remaining questions in Section B both in terms of your organization AND others with whom you contract.

B3. Typically, care management involves direct intervention with members. But it may also involve working with members’ physicians (for example, by promoting adherence to evidence-based care guidelines).

Does care management under this contract include patient-oriented intervention, physician-oriented intervention, or both?

mark one

1  Physician-oriented intervention only — Go to C1; (the rest of the questions in Section B pertain to interventions with members)

2  Member-oriented intervention only — Go to B4

3  Both physician- and member-oriented intervention — Go to B4

B4. Approximately what percentage of members who were enrolled under this contract in 2007 used care management (that is, they were directly contacted by care managers)? Your best estimate is fine.

| | | | % Percent using care management in 2007

B5. Please indicate the criteria used to determine member eligibility for care management.

mark yes or no for each	Yes	No
a. High cost of care or high service use (past or expected in the future)	1 	0 
b. Specific health events or procedures (such as surgeries)	1 	0 
c. Gaps in care (such as the lack of needed diagnostic testing)	1 	0 
d. High prescription drug use	1 	0 
e. Functional limitations	1 	0 
f. Specific diagnoses or conditions, or medical complexity	1 	0 
g. Specific lab values or clinical indicators out of range	1 	0 
h. Need for palliative or end-of-life care	1 	0 
i. Please list other criteria used to determine eligibility for care management	1 	0 

B6. Please indicate the approaches used to identify members for care management.

mark yes or no for each	Yes	No
a. Claims review or predictive model (based on service or prescription drug use, costs, diagnoses, or procedures)	1 	0 
b. Clinical or diagnostic data review (including review of Medicare Advantage risk scores)	1 	0 
c. Provider referral	1 	0 
d. Nonclinical staff referral (including customer service or pre‑certification staff)	1 	0 
e. Member self-referral	1 	0 
f. Administration of a health risk assessment	1 	0 
g. Please list other approaches used to identify members for care management	1 	0 

B7. Please indicate the criteria your organization uses to exclude members from care management.

mark yes or no for each	Yes	No
a. Terminal illness or participation in hospice	1 	0 
b. Dementia	1 	0 
c. End Stage Renal Disease (ESRD)	1 	0 
d. Please list other criteria used to exclude members from care management	1 	0 
e. No exclusion criteria used	1 	0 

B8. Please indicate the types of professional staff providing care management under this contract. (Please remember to include any staff NOT directly employed by your organization who provide such care.)

mark yes or no for each	Yes	No
a. Nurses:
1. Advance practice nurses	1 	0 
2. Registered nurses	1 	0 
3. Licensed practical or vocational nurses	1 	0 
b. Staff other than nurses:
1. Social workers	1 	0 
2. Physical, occupational, speech, or respiratory therapists	1 	0 
3. Behavioral health specialists or therapists	1 	0 
4. Pharmacy staff	1 	0 
5. Registered dietician	1 	0 
6. Primary care physicians	1 	0 
7. Please list other types of staff providing care management	1 	0 

B8a. Do care managers serve only members covered under this (Medicare) contract, or do they also serve members covered under other (non-Medicare) contracts?

1  Care managers serve only members with Medicare

2  Care managers also serve younger members covered under commercial contracts or other

non-Medicare covered members

B9. Some care management programs formally assign members receiving care management to levels, for example depending on the complexity of the members’ problems. Does your care management program have different levels?

1  Yes — Please answer questions in the rest of Section B for the care management level to which most members are assigned. (Continue to B10)

0  No — Continue to B10

B10. Does care management include a comprehensive assessment of member health and health-related needs (for example, an assessment that goes beyond a brief health risk assessment)?

1  Yes — Go to B11

0  No — Go to B12

B11. Please indicate the types of staff who conduct comprehensive assessments.

mark all that apply

1  Clinical staff directly employed by or contracted with your organization

(such as nurses, social workers, or physicians)

2  Non-clinical staff directly employed by or contracted with your organizations

(such as customer relations or outreach staff)

3  No staff involved; assessments are self-administered

B12. What is the usual mode of contact with individual members in care management? (Do not include mass mailings of health-related literature.)

mark one

1  In person

2  Telephone

3  Mail

4  Email or internet website

B13. Do members in care management receive education about how to better manage chronic conditions or disabilities?

1  Yes — Go to B14

0  No — Go to B15

B14. How is education provided to members in care management?

mark yes or no for each	Yes	No
a. Staff follow curriculum with individual members	1 	0 
b. Staff follow curriculum addressing groups of members	1 	0 
c. Staff follow checklists	1 	0 
d. Staff use scripts provided by computer algorithm	1 	0 
e. Staff use teachable moments	1 	0 
f. Staff provide written material to members	1 	0 
g. Staff provide videos or DVDs to members	1 	0 
h. On-line education available to members	1 	0 
i. Please list other ways education is provided	1 	0 

B15. Does care management include managing or assisting members with care setting transitions such as hospital or nursing home discharges?

1  Yes — Go to B16

0  No — Go to B18

B16. How do care managers identify care setting transitions?

mark yes or no for each	Yes	No
a. Staff receive information based on pre-admission screening or benefit advisory review	1 	0 
b. Staff routinely review facility admissions logs	1 	0 
c. Hospitals routinely notify contract holder of all members admitted or discharged	1 	0 
d. Staff relies on primary physicians to report transition	1 	0 
e. Staff relies on members or caregivers to report transition	1 	0 
f. Please list other ways care transitions are identified	1 	0 

B17. How do care managers respond to setting transitions such as facility discharges?

mark yes or no for each	Yes	No
a. Work with facility staff throughout stay	1 	0 
b. Work with facility staff only in advance of discharge	1 	0 
c. Assist with implementing facility discharge plan	1 	0 
d. Make arrangements with providers identified in discharge plan	1 	0 
e. Telephone members to follow up on discharge arrangements	1 	0 
f. Visit members to follow up on discharge arrangements	1 	0 
g. Review member medications either by telephone or visit	1 	0 
h. Please list other ways your staff help with a facility discharge	1 	0 

B18. Does care management include identifying and resolving member problems related to medications?

1  Yes — Go to B19

0  No — Go to B21

B19. How are member problems with medications identified?

mark yes or no for each	Yes	No
a. Pharmacy Benefit Manager (PBM) identifies problems	1 	0 
b. Care managers, pharmacists, or other staff review reports on prescription drug claims (possibly using software that identifies potential problems)	1 	0 
c. Care managers administer screening instrument to members concerning medications taken	1 	0 
d. Members discuss medications and problems with care managers during routine contacts	1 	0 
e. Primary care physicians or other providers report medications and related problems to care managers	1 	0 
f. Please list other ways problems with medications are identified	1 	0 

B20. How do care managers respond to member problems with medications?

mark yes or no for each	Yes	No
a. Ask pharmacist to review medications to identify solution	1 	0 
b. Notify primary care physician to resolve	1 	0 
c. Notify all relevant physicians to resolve	1 	0 
d. Disease manager (or pharmacist) can adjust some medications using standing protocols	1 	0 
e. Provide member education or refer member to Medication Therapy Management Program (MTMP)	1 	0 
f. Notify member of problem and suggested solution	1 	0 
g. Please list other ways care managers respond to problems with medications	1 	0 

B21. Does care management include assisting members with access to support services such as personal care, transportation to medical appointments, assistance applying for Medicaid, or financial assistance programs?

1  Yes — Go to B22

0  No — Go to B23

B22. How do care managers identify member need for support services?

mark all that apply

1  Periodically assess need for support services of members receiving care management

2  Physicians or other providers refer members requiring support services

3  Please list other ways members needs are identified

B23. Do care managers assess the availability of care from family members, health care decision makers, friends, or other unpaid helpers?

1  Yes

0  No

B24. What is the duration of care management, on average, for members using this service? Your best estimate is fine.

| | | | 1  Days

Number of 2  Weeks

3  Months

4  Program duration is not limited — Go to Section C

B25. Please describe one or two main criteria for discharge from your care management program.

B26. During 2007, approximately what percentage of care management program users were discharged within one year of start of care management? Your best estimate is fine.

| | | | % Percentage discharged within one year

Section C: Characteristics of Disease Management Programs

C1. Is disease management available to members served under this contract?

As noted earlier in the instructions, for the purposes of this survey, by disease management we mean:

Services that: teach members how to adhere to their physicians’ treatment plans; monitor member clinical status and adherence to treatment recommendations; and monitor provider adherence to evidence-based practice guidelines. Disease management is typically targeted to members with specific chronic diseases, such as heart failure or diabetes. Such diseases often have complex treatment regimens, and maintaining adherence requires the sustained efforts of patients and physicians.

1  Yes — Go to C2

0  No — Go to Section D

C2. Is disease management provided by staff employed by the contract holder, a vendor, network providers (such as primary care physicians), or others not directly employed by the contract holder?

mark all that apply

1  Contract holder staff

2  Vendor

3  Plan network provider

4  Provided by other non-contract holder staff (Please specify)

Remember, if your organization contracts out some or all of its disease management services (for example, to a disease management vendor), please answer the remaining questions in Section C both in terms of your organization AND others with whom you contract.

C3. For what diagnoses is disease management offered?

mark yes or no for each	Yes	No
a. Congestive Heart Failure (CHF)	1 	0 
b. Other chronic cardiac diagnoses such as Coronary Artery Disease (CAD)	1 	0 
c. Diabetes	1 	0 
d. Chronic Obstructive Pulmonary Disease (COPD)	1 	0 
e. Other chronic respiratory diagnoses (such as asthma)	1 	0 
f. Chronic kidney disease	1 	0 
g. High cholesterol	1 	0 
h. High blood pressure	1 	0 
i. Other diagnoses (Please specify)	1 	0 

C4. Typically, disease management involves direct intervention with members. But it may also involve working with members’ physicians (for example, by promoting adherence to evidence-based care guidelines).

Does disease management under this contract include patient-oriented intervention, physician-oriented intervention, or both?

mark one

1  Physician-oriented intervention only — Go to D1 (the rest of the questions in Section C pertain to interventions with members)

2  Member-oriented intervention only — Go to C4a

3  Both physician- and member-oriented intervention — Go to C4a

C4a. Is disease management under this contract a population-based or opt-in program?

mark one

1  Population-based, including all members with targeted diagnoses or conditions

2  Population-based, with opt-out provisions for members who do not wish to participate

3  Opt-in (members with targeted diagnoses or conditions are invited to participate and must agree to participate)

C5. Approximately what percentage of members who were enrolled under this contract in 2007 used disease management (that is, they were directly contacted by disease managers)? Your best estimate is fine.

| | | | % Percent using disease management in 2007

C6. Please indicate the criteria used to determine member eligibility for disease management, in addition to medical diagnosis.

mark yes or no for each	Yes	No
a. High cost of care or high service use (past or expected in the future)	1 	0 
b. Specific health events or procedures (such as surgeries)	1 	0 
c. Gaps in care (such as the lack of needed diagnostic testing)	1 	0 
d. High prescription drug use	1 	0 
e. Specific diagnoses or conditions (in addition to those mentioned in C3) or medical complexity	1 	0 
f. Specific lab values or clinical indicators out of range	1 	0 
g. Please list other criteria used to determine eligibility for disease management	1 	0 

C7. Please indicate the approaches used to identify members for disease management.

mark yes or no for each	Yes	No
a. Claims review or predictive model (based on service or prescription drug use, costs, diagnoses, or procedures)	1 	0 
b. Clinical or diagnostic data review (including review of Medicare Advantage risk scores)	1 	0 
c. Provider referral	1 	0 
d. Nonclinical staff referral (including customer service or pre‑certification staff)	1 	0 
e. Member self-referral	1 	0 
f. Administration of a health risk assessment	1 	0 
g. Please list other approaches used to identify members for care management	1 	0 

C8. Please indicate the criteria your organization uses to exclude members from disease management.

mark yes or no for each	Yes	No
a. Terminal illness or participation in hospice	1 	0 
b. Dementia	1 	0 
c. End Stage Renal Disease (ESRD)	1 	0 
d. Please list other criteria used to exclude members from disease management	1 	0 
e. No exclusion criteria used	1 	0 

C9. Please indicate the types of professional staff providing disease management under this contract. (Please remember to include any staff NOT directly employed by your organization who provide such care.)

mark yes or no for each	Yes	No
a. Nurses:
1. Advance practice nurses	1 	0 
2. Registered nurses	1 	0 
3. Licensed practical or vocational nurses	1 	0 
b. Staff other than nurses:
1. Social workers	1 	0 
2. Physical, occupational, speech, or respiratory therapists	1 	0 
3. Behavioral health specialists or therapists	1 	0 
4. Pharmacy staff	1 	0 
5. Registered dieticians	1 	0 
6. Primary care physicians	1 	0 
7. Please list other types of staff providing disease management	1 	0 

C9a. Do disease managers serve only members covered under this (Medicare) contract, or do they also serve members covered under other (non-Medicare) contracts?

1  Disease managers serve only members with Medicare

2  Disease managers also serve younger members covered under commercial contracts or

other non-Medicare covered members

C10. Some disease management programs formally assign members receiving disease management to levels, for example depending on the severity of the members’ conditions. Does your disease management program have different levels?

1  Yes — Please answer questions in the rest of Section C for the disease management level to which most members are assigned. (Continue to C11)

0  No — Continue to C11

C11. Does disease management include a comprehensive assessment of member health and health related needs (for example, an assessment that goes beyond a brief health risk assessment)?

1  Yes — Go to C12

0  No — Go to C13

C12. Please indicate the types of staff who conduct comprehensive assessments.

mark all that apply

1  Clinical staff directly employed by or contracted with your organization

(such as nurses, social workers, or physicians)

2  Non-clinical staff directly employed by or contracted with your organizations

(such as customer relations or outreach staff)

3  No staff involved; assessments are self-administered

C13. What is the usual mode of contact with individual members in disease management? (Please do not include mass mailings of health-related literature.)

mark one

1  In person

2  Telephone

3  Mail

4  Email or internet website

C14. Do members in disease management receive education about how to better manage chronic conditions?

1  Yes — Go to C15

0  No — Go to C16

C15. How is education provided to members in disease management?

mark yes or no for each	Yes	No
a. Staff follow curriculum with individual members	1 	0 
b. Staff follow curriculum addressing groups of members	1 	0 
c. Staff follow checklists	1 	0 
d. Staff use scripts provided by computer algorithm	1 	0 
e. Staff use teachable moments	1 	0 
f. Staff provide written material to members	1 	0 
g. Staff provide videos or DVDs to members	1 	0 
h. On-line education available to members	1 	0 
i. Please list other ways education is provided	1 	0 

C16. Does disease management include managing or assisting members with care setting transitions such as hospital or nursing home discharges?

1  Yes — Go to C17

0  No — Go to C19

C17. How do disease managers identify care setting transitions?

mark yes or no for each	Yes	No
a. Staff receive information based on pre-admission screening or benefit advisory review	1 	0 
b. Staff routinely review facility admissions logs	1 	0 
c. Hospitals routinely notify contract holder of all members admitted or discharged	1 	0 
d. Staff relies on primary physicians to report transition	1 	0 
e. Staff relies on members or caregivers to report transition	1 	0 
f. Please list other ways care transitions are identified	1 	0 

C18. How do disease managers respond to setting transitions such as facility discharges?

mark yes or no for each	Yes	No
a. Work with facility staff throughout stay	1 	0 
b. Work with facility staff only in advance of discharge	1 	0 
c. Assist with implementing facility discharge plan	1 	0 
d. Make arrangements with providers identified in discharge plan	1 	0 
e. Telephone members to follow up on discharge arrangements	1 	0 
f. Visit members to follow up on discharge arrangements	1 	0 
g. Review member medications either by telephone or visit	1 	0 
h. Please list other ways your staff help with a facility discharge	1 	0 

C19. Does disease management include identifying and resolving member problems related to medications?

1  Yes — Go to C20

0  No — Go to C22

C20. How are member problems with medications identified?

mark yes or no for each	Yes	No
a. Pharmacy Benefit Manager (PBM) identifies problems	1 	0 
b. Disease managers, pharmacists, or other staff review reports on prescription drug claims (possibly using software that identifies potential problems)	1 	0 
c. Disease managers administer screening instrument to members concerning medications taken	1 	0 
d. Members discuss medications and problems with disease managers during routine contacts	1 	0 
e. Primary care physicians or other providers report medications and related problems to disease managers	1 	0 
f. Please list other ways problems with medications are identified	1 	0 

C21. How do disease managers respond to member problems with medications?

mark yes or no for each	Yes	No
a. Ask pharmacist to review medications to identify solution	1 	0 
b. Notify primary care physician to resolve	1 	0 
c. Notify all relevant physicians to resolve	1 	0 
d. Disease manager (or pharmacist) can adjust some medications using standing protocols	1 	0 
e. Provide member education or refer member to Medication Therapy Management Program (MTMP)	1 	0 
f. Notify member of problem and suggested solution	1 	0 
g Please list other ways disease managers respond to problems with medications	1 	0 

C22. What is the duration of disease management, on average, for members using this service? Your best estimate is fine.

| | | | 1  Days

Number of 2  Weeks

3  Months

4  Program duration is not limited — Go to Section D

C23. Please describe the one or two main criteria for discharge used by your disease management program.

C24. During 2007, approximately what percentage of disease management program users were discharged within one year of start of disease management? Your best estimate is fine.

| | | | % Percentage discharged within one year

Section D: Physician Interventions under Care or Disease Management

D1. Are physicians expected to collaborate with your care or disease managers, for example, by calling them with new information about patients or participating in multi-disciplinary team meetings?

1  Yes, required by contract

2  Yes, encouraged to collaborate (but not contractually required)

0  No, not expected

D2. Are physicians provided with decision support tools such as evidence-based practice guidelines or patient-specific reports showing gaps in care?

1  Yes

0  No

D3. Does your organization offer feedback on provider performance concerning patients receiving care or disease management services?

1  Yes

0  No

Section E: Care and Disease Management Differences Between Regular Medicare Advantage Plans and Special Needs Plans (SNPs)

E1. Does this contract include one or more regular (traditional) Medicare Advantage (MA) plans AND one or more Special Needs Plans (or SNPs) that offer care management or disease management?

1  Yes, contains regular MA plan and SNP — Go to E2

0  No, contains just regular MA plan(s) or just SNP(s) — Go to Section F

E2. What are the main differences between care and disease management under the contract’s SNP compared to under the contract’s regular Medicare Advantage plans?

1  No difference — Go to Section F

2  Some differences — Go to E3

E3. Please indicate the main differences between your care or disease management under SNP and under the contract’s regular Medicare Advantage plans.

mark all that apply

1  Higher proportions of SNP members use services (or use services

at higher levels of complexity, if use of such levels reported above)

2  Services are of longer duration under the SNP

3  Staff have smaller caseloads under the SNP

4  Services are more structured under the SNP (for example,

staff rely more on written protocols)

5  Please describe other differences with your SNP

Section F: Evidence of Effectiveness and Assessment of Costs

F1. Does your organization determine the success of its care and disease management services using any of the following criteria?

mark yes or no for each	Yes	No
a. Reduced costs of care	1 	0 
b. Reduced rates of preventable admissions	1 	0 
c. By whether specific care is received, such as diagnosis-specific screenings or immunizations	1 	0 
d. By specific health outcomes, such as improved clinical indicators for levels of blood pressure, cholesterol, or blood glucose	1 	0 
e. Improved member satisfaction	1 	0 
f. By meeting operational performance standards, such as care or disease manager frequency of contact with members	1 	0 
g. Please describe other ways your plan may define success	1 	0 

F2. What data (or other information) does your organization use to determine the success of care and disease management?

mark yes or no for each	Yes	No
a. Claims for covered services	1 	0 
b. Clinical data collected directly	1 	0 
c. Clinical data providers report to the plan	1 	0 
d. Self-reported (member) health or satisfaction	1 	0 
e. Please describe other ways your plan measures success	1 	0 
f. Does not formally determine success	1 	0 

F3. To determine success, do you compare these measures to the following values?

mark yes or no for each	Yes	No
a. National or local managed care benchmarks	1 	0 
b. National or local fee-for-service benchmarks	1 	0 
c. Members’ baseline values	1 	0 
d. Please describe other bases for comparisons	1 	0 
e. Does not formally determine success	1 	0 

F4. Is your care or disease management program viewed as a separate marketable plan benefit, a management tool, or both?

mark all that apply

1  Separate marketable plan benefit

2  Utilization and risk management tool

3  Quality management tool

4  Please describe other purposes for care and disease management under this contract

F5. Does your organization also provide care or disease management in the fee-for-service sector?

1  Yes

0  No

F6. Please attach examples of internal evaluations of care or disease management your organization has conducted, if willing to share them with CMS.

F7. Thank you for completing the questionnaire. Please return it in the enclosed postage paid envelope. If you have additional information about your care or disease management program that you think may be of interest to this evaluation, please include it with the completed questionnaire.

If you have misplaced the envelope, please send your completed questionnaire to: Emily Dwoyer at Mathematica Policy Research, Inc. (MPR), P.O. Box 2393, Princeton, NJ 08543-2393.

DRAFT

Prepared by Mathematica Policy Research, Inc.